Persistent Throat Discomfort and Brown Mucus: Possible Causes and Solutions

Sore throat with brownish, stringy (or small clumpy) phlegm?

Hello Doctor, I have been experiencing a persistent sensation of something stuck in my throat along with phlegm for nearly two months.
The phlegm does not resemble the typical yellow or green color seen in common colds; instead, it is transparent with brownish, fibrous or chunky material mixed in.
I have to exert significant effort to cough it out, and even after that, I need to cough multiple times to clear it completely.
During this period, I consulted an otolaryngologist (who performed a nasopharyngoscopy with no abnormalities found), a pulmonologist (who conducted a chest X-ray with no abnormalities), and a gastroenterologist (who performed an endoscopy revealing moderate gastroesophageal reflux disease).
I have also taken antibiotics, but there has been no improvement.
I quit smoking a little over two months ago, and I would like to ask if this could be related to my smoking cessation or if there might be other possible causes.
Thank you.

Lin Xiansheng, 30~39 year old female. Ask Date: 2024/04/21

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on the symptoms you described, you have undergone a series of evaluations, including assessments from otolaryngology, pulmonology, and gastroenterology, and it has been found that you have moderate gastroesophageal reflux disease (GERD).
Here are some possible causes and related factors:
1.
Chronic pharyngitis.
2.
Gastroesophageal reflux disease (GERD): You mentioned having moderate GERD, which may be one of the reasons for throat discomfort and increased phlegm.
The reflux of stomach acid into the esophagus and throat can cause irritation, leading to coughing and phlegm production.
3.
Chronic bronchitis: If you have a long history of smoking, you may have chronic bronchitis, which can lead to coughing and phlegm production.
Even after quitting smoking, these symptoms may persist for some time.
4.
Allergies or environmental factors: Allergic reactions or sensitivity to certain environmental irritants (such as dust mites, pollen, pet dander, etc.) may cause throat discomfort and phlegm production.
5.
Other respiratory diseases: Although your chest X-ray results are normal, there may still be other respiratory issues, such as asthma or other chronic lung diseases.
Chronic pharyngitis refers to the chronic inflammation of the pharynx, which is a common condition that can be caused by various factors.
The characteristics of chronic pharyngitis include persistent discomfort in the throat, such as sore throat, dryness, irritation, a sensation of a foreign body, or increased phlegm.
These symptoms may last for weeks or even months and may recur.
Possible causes of chronic pharyngitis include:
1.
Long-term smoking or exposure to secondhand smoke.
2.
Inhalation of air pollutants or harmful substances.
3.
Prolonged or repetitive use of the vocal cords, such as in professional use (e.g., teachers, singers).
4.
Long-term irritation from alcohol and spicy foods.
5.
Gastroesophageal reflux disease (GERD), where stomach acid reflux may irritate the throat.
6.
Chronic rhinitis, sinusitis, or allergies leading to post-nasal drip.
7.
Side effects of certain medications, especially those that may cause dry mouth or alter saliva secretion.
8.
Long-term or improper use of throat sprays or lozenges.
9.
Immune system disorders or other chronic diseases.
Treatment for chronic pharyngitis typically requires addressing the underlying causes of inflammation.
This may include:
- Lifestyle changes, such as quitting smoking and avoiding alcohol and spicy foods.
- Managing gastroesophageal reflux disease, which may involve dietary adjustments and medication.
- Avoiding prolonged talking or loud speaking to give the throat adequate rest.
- If caused by allergies, antihistamines or allergen desensitization therapy may be necessary.
If you suspect you have chronic pharyngitis, you should consult a physician for an accurate diagnosis and to develop an appropriate treatment plan.
The doctor may recommend some examinations, such as laryngoscopy, to assess the condition of the throat.
These are general recommendations based on the symptoms you described and should not replace professional medical advice from an in-person consultation with a physician.

Reply Date: 2024/04/21

More Info

Persistent throat discomfort accompanied by brown mucus can be a perplexing issue, especially when it has lasted for two months and has not improved despite various medical evaluations and treatments. The symptoms you describe, including the difficulty in clearing the mucus and the presence of brownish particles, warrant a closer examination of potential underlying causes.

Firstly, it is important to consider that the brown color of the mucus could be indicative of several factors. One possibility is that it may contain old blood, which can occur due to irritation or inflammation in the throat or respiratory tract. This could be a result of chronic irritation from smoking, especially since you mentioned that you recently quit smoking. Smoking can lead to chronic bronchitis, which may cause mucus production and irritation in the airways. After quitting, your body may be in a state of recovery, leading to increased mucus production as it clears out the remnants of smoking.

Another potential cause could be related to gastroesophageal reflux disease (GERD), which you mentioned was diagnosed during your gastrointestinal evaluation. GERD can lead to the backflow of stomach acid into the esophagus and throat, causing irritation and inflammation. This irritation can manifest as a sensation of a lump in the throat (often referred to as "globus sensation") and increased mucus production. The brownish color of the mucus could be due to the presence of bile or other substances from the stomach.

Additionally, environmental factors such as exposure to pollutants, allergens, or irritants can contribute to throat discomfort and mucus production. If you have recently moved to a new area or have been exposed to new substances, this could also be a contributing factor.

Given that you have already undergone several evaluations, including endoscopic examinations and imaging studies, and have not found any significant abnormalities, it may be beneficial to consider a few additional approaches:
1. Hydration and Humidification: Ensure that you are well-hydrated, as this can help thin mucus and make it easier to expel. Using a humidifier in your living space can also help keep the air moist, which may alleviate throat discomfort.

2. Avoiding Irritants: Since you have recently quit smoking, it is crucial to avoid other irritants such as secondhand smoke, strong odors, and pollutants. This will help your throat heal and reduce irritation.

3. Dietary Modifications: If GERD is a contributing factor, consider dietary changes to minimize reflux symptoms. This may include avoiding spicy foods, caffeine, and large meals before bedtime.

4. Follow-Up with Specialists: If symptoms persist, it may be worthwhile to follow up with an ear, nose, and throat (ENT) specialist or a pulmonologist for further evaluation. They may consider additional tests, such as a CT scan of the sinuses or a trial of proton pump inhibitors (PPIs) to manage GERD symptoms.

5. Speech Therapy: Sometimes, persistent throat discomfort can be alleviated through voice therapy or speech therapy, especially if there is a component of muscle tension dysphonia or if you have developed compensatory habits due to discomfort.

In conclusion, while your symptoms may be related to your recent smoking cessation, they could also be influenced by GERD or other environmental factors. It is essential to continue working with your healthcare providers to explore these possibilities and find an effective treatment plan. If symptoms do not improve, further investigation may be necessary to rule out any other underlying conditions.

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